Healthcare Provider Details

I. General information

NPI: 1609391598
Provider Name (Legal Business Name): CHARLES ERIC FLYNN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 SINGLETON RIDGE RD
CONWAY SC
29526-9150
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTN CREDENTIALING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-8050
  • Fax: 843-347-8049
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5969
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: